Early cardia neoplasms in the upper gastrointestinal tract have a higher detection rate under sedation: a retrospective cohort study based on the Chinese population.
Esophagogastroduodenoscopy (EGD) is a standard method for upper gastrointestinal (UGI) tumor screening. However, differing opinions persist regarding the impact of sedation on the detection rate of early adenocarcinoma of the gastric cardia (EGCA). This study evaluated the effect of sedation on the detection of EGCA, other upper digestive tract early cancer (UDTEC) and microscopic upper gastrointestinal (UGI) lesion detection.
We retrospectively analyzed 313,503 symptomatic and screening patients undergoing EGD (2018-2025) at Zhejiang Provincial Hospital of Traditional Chinese Medicine and Zhejiang Provincial People's Hospital. Histopathological biopsy data defined positive outcomes as EGCA and other UGI early cancers (esophageal, gastric, duodenal). Propensity score matching (PSM) assessed sedation-tumor detection associations. Primary outcomes included UGI precancerous lesions, UDTEC rates, and microscopic tumor yield (lesions/subjects). Secondary outcomes identified detection determinants via logistic regression.
Sedation was associated with modest but statistically significant higher detection rates of EGCA, overall UDTEC and UGI microscopic tumor foci compared with non-sedated EGD (EGCA: p< 0.001; UDTEC: p< 0.001; UGI microscopic tumor lesions: p< 0.001). Univariate/multivariate analyses identified gender, age, title of examining physician, years of practice, and examination time as independent detection predictors. After PSM (198,846 patients in total), sedation remained significantly associated with increased detection of EGCA (OR = 1.400, 95% CI 1.030-1.901, p = 0.026), overall UDTEC (OR = 1.196, 95% CI 1.102-1.295, p< 0.001) and microscopic tumor foci (OR = 6.861, 95% CI 3.278-14.367, p < 0.001).
In this large retrospective cohort study of over 300,000 EGD subjects, sedation was associated with statistically significant but modestly higher detection rates of early gastric cardia adenocarcinoma, upper gastrointestinal precancerous lesions and overall upper digestive tract early cancers. The most prominent benefit of sedation was the improved detection of easily missed microscopic tumor foci. These findings support the consideration of sedation as a quality improvement option to enhance diagnostic yield for subtle early neoplasms, while acknowledging the relatively limited absolute gains in overall detection rates for unselected populations.
We retrospectively analyzed 313,503 symptomatic and screening patients undergoing EGD (2018-2025) at Zhejiang Provincial Hospital of Traditional Chinese Medicine and Zhejiang Provincial People's Hospital. Histopathological biopsy data defined positive outcomes as EGCA and other UGI early cancers (esophageal, gastric, duodenal). Propensity score matching (PSM) assessed sedation-tumor detection associations. Primary outcomes included UGI precancerous lesions, UDTEC rates, and microscopic tumor yield (lesions/subjects). Secondary outcomes identified detection determinants via logistic regression.
Sedation was associated with modest but statistically significant higher detection rates of EGCA, overall UDTEC and UGI microscopic tumor foci compared with non-sedated EGD (EGCA: p< 0.001; UDTEC: p< 0.001; UGI microscopic tumor lesions: p< 0.001). Univariate/multivariate analyses identified gender, age, title of examining physician, years of practice, and examination time as independent detection predictors. After PSM (198,846 patients in total), sedation remained significantly associated with increased detection of EGCA (OR = 1.400, 95% CI 1.030-1.901, p = 0.026), overall UDTEC (OR = 1.196, 95% CI 1.102-1.295, p< 0.001) and microscopic tumor foci (OR = 6.861, 95% CI 3.278-14.367, p < 0.001).
In this large retrospective cohort study of over 300,000 EGD subjects, sedation was associated with statistically significant but modestly higher detection rates of early gastric cardia adenocarcinoma, upper gastrointestinal precancerous lesions and overall upper digestive tract early cancers. The most prominent benefit of sedation was the improved detection of easily missed microscopic tumor foci. These findings support the consideration of sedation as a quality improvement option to enhance diagnostic yield for subtle early neoplasms, while acknowledging the relatively limited absolute gains in overall detection rates for unselected populations.
Authors
Chen Chen, Zhou Zhou, Feng Feng, Shi Shi, Shen Shen, Sun Sun, Bi Bi, Zhang Zhang
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